We normally do not cover drugs filled at an out-of-network pharmacy. We have network pharmacies outside of our service areas. When you are not able to use a network pharmacy we will pay for your drug in the following cases:
- When you are out of the area, require a drug to be filled unexpectedly, and are unable to obtain your drugs at a network pharmacy.
- During a declared disaster in your service area and you cannot use a network pharmacy.
- Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available, up to a 30-day supply.
You can use our Find a Doctor or Pharmacy tool to help you locate a pharmacy that is in our network.
Call Member Services at 1-866-549-8289. Hours are from 8 a.m. to 8 p.m., Monday through Friday. On weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.
Will the plan pay you back for a prescription?
If you must use an out-of-network pharmacy, you will have to pay the full cost instead of your share of the cost when you fill your drug. You can ask us to pay you back for our share of the cost.
Last Updated: 03/02/2018
We have thousands of pharmacies in our nationwide network to make it easy to get your drugs. We know there may be times when you can't use a network pharmacy. We may cover prescriptions filled at an out-of-network pharmacy:
- If you do not receive more than a 30-day supply, and
- If there is no network pharmacy that is close to you and open, or
- If you need a drug that you can’t get at a network pharmacy close to you, or
- If you need a drug for emergency or urgent medical care, or
- If you must leave your home due to a federal disaster or other public health emergency.
Always contact Member Services first to see if there is a network pharmacy close to you.
If you must use an out-of-network pharmacy, you will generally have to pay the full cost of your drug. You can ask us to pay you back for our share of the cost.
How do you ask us to pay you back?
- Complete the Prescription Claim Form - English (PDF) | Prescription Claim Form - Español (PDF).
- Attach the original prescription receipt to the form. If you d o not have the original receipt, you can ask your pharmacy for a printout. Do not use cash register receipts.
- Mail the completed form and receipt to the address on the form.
After we receive your request, we will mail our decision (determination) with a reimbursement check (if applicable) within 14 days. For specific information about drug coverage, refer to your Member Handbook or contact Member Services. We are here to help.
Last updated: 10/04/2018